Study finds mix of disease processes at work in brains of most people with dementia

Few older people die with brains untouched by a pathological process, however, an individual’s likelihood of having clinical signs of dementia increases with the number of different disease processes present in the brain, according to a new study. The research was funded by the National Institute on Aging (NIA), part of the National Institutes of Health, and conducted at the Rush Alzheimer’s Disease Center at Rush University Medical Center in Chicago. Julie Schneider, M.D., and colleagues report the findings in the journal Neurology online today.

Among their findings is the observation that the combination of Alzheimer’s disease and cerebral infarcts (strokes) is the most common mix of pathologies in the brains of people with dementia. The implication of these findings is that public health efforts to prevent and treat vascular disease could potentially reduce the occurrence of dementia, the researchers say in the paper.

The researchers used data from the Rush Memory and Aging Project — an ongoing study of 1,200 elderly volunteers who have agreed to be evaluated every year and to donate their brains upon death. The current study compared clinical and autopsy data on the first 141 participants who have died.

Annual physical and psychological exams showed that, while they were alive, 50 of the 141 had dementia. Upon death, a neuropathologist, who was unaware of the results of the clinical evaluation, analyzed each person’s brain. The autopsies showed that about 85 percent of the individuals had evidence of at least one chronic disease process, such as Alzheimer’s disease, strokes, Parkinson’s disease, hemorrhages, tumors, traumatic brain injury or others.

Comparison of the clinical and autopsy results showed that only 30 percent of people with signs of dementia had Alzheimer’s disease alone. By contrast, 42 percent of the people with dementia had Alzheimer’s disease with infarcts and 16 percent had Alzheimer’s disease with Parkinson’s disease (including two people with all three conditions). Infarcts alone caused another 12 percent of the cases. Also, 80 of the 141 volunteers who died had sufficient Alzheimer’s disease pathology in their brains to fulfill accepted neuropathologic criteria for Alzheimer’s disease, although in life only 47 were clinically diagnosed with probable or possible Alzheimer’s disease.

“We know that people can have Alzheimer’s pathology without having symptoms,” says Dallas Anderson, Ph.D., population studies program director in the NIA Neuroscience and Neuopsychology of Aging Program. “The finding that Alzheimer’s pathology with cerebral infarcts is a very common combination in people with dementia adds to emerging evidence that we might be able to reduce some of the risk of dementia with the same tools we use for cardiovascular disease such as control of blood cholesterol levels and hypertension.”

NIA is conducting clinical trials to determine whether interventions for cardiovascular disease can prevent or slow the progress of Alzheimer’s disease. On-going trials cover a range of interventions such as statin drugs, vitamins and exercise.

NIA leads the federal effort supporting and conducting research on aging and the medical, social and behavioral issues of older people, including Alzheimer’s disease and age-related cognitive decline. For information on dementia and aging, please visit NIA’s Alzheimer’s Disease Education and Referral Center at www.nia.nih.gov/alzheimers[1], or call 1-800-438-4380. For more general information on research and aging, go to www.nia.nih.gov[2].

The National Institutes of Health (NIH) — The Nation's Medical Research Agency — includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov[3].